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(Denosumab, Xgeva) is a drug produced by the American company Amgen for the treatment of malignant tumors with bone metastasis. Which is most commonly used in our breast cancer patients with bone metastases. Denosumab is a transmembrane or soluble protein that plays an important role in the formation, function, and survival of osteoclasts and cells responsible for bone resorption, regulating the release of calcium from bone. Through RANKL stimulation, osteoclast activity is enhanced, mediating the occurrence of bone metastasis bone pathology in solid tumors. Denosumab can bind to the RANKL protein, preventing RANKL from binding to the receptor RANK expressed on the surface of osteoclasts, precursor cells, and osteoclast-like giant cells to activate subsequent malignant processes, thus exerting an anti-bone metastasis effect.

First of all, we need to understand the injection method and dosage of denosumab:

(1) Give 120/mg by subcutaneous injection in the upper arm, upper thigh, or abdomen once every 4 weeks.

(2) Give calcium and vitamin D when necessary to treat or prevent hypocalcemia. Here are some things to note:

(1) Hypocalcemia, severe hypocalcemia, may occur in patients receiving Xgeva. Correct hypocalcemia before starting Xgeva. Monitor calcium levels and appropriately supplement all patients with calcium and vitamin D.

(2) Osteonecrosis of the jaw may occur in patients receiving Xgeva. Have an oral examination before starting Xgeva. Monitor for symptoms. Avoid Invasive Dental Surgical Adverse Reactions During Treatment with Xgeva The most common adverse reactions (incidence greater than or equal to 25% of patients per case-patient) receiving Xgeva were fatigue/asthenia, hypophosphatemia, and nausea.

Finally, before we choose denosumab treatment, we need to understand whether we are contraindicated for this drug:

(1) Pregnancy: According to animal data, it may cause fetal damage. Pregnancy monitoring programs are available.

(2) Nursing mothers: Mammary gland development and lactation may be impaired. Discontinue medication or breastfeeding.

(3) Pediatric patients: Solace and effectiveness have not been determined.

(4) Renal impairment: Patients with creatinine clearance less than 30 mL/min or receiving dialysis are at risk for hypocalcemia. If you are one of the above contraindications, it is best to discuss with your doctor about changing other anti-cancer drugs for treatment.